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Prior authorization

Prior authorization by Security Health Plan is required before receiving certain services to ensure coverage and payment for those services. Please have your doctor complete a prior authorization form and submit it to Security Health Plan if you plan to receive any of these services.

When is prior authorization needed?

Security Health Plan requires prior authorization for some medical services or equipment. While a provider will generally make these requests and submit the necessary forms, it is a member’s responsibility to make sure the process is followed. A health care provider may contact Security Health Plan to determine whether a prior authorization is required for a member’s service or medical equipment by calling our Provider Assistance Line at 1-800-548-1224.   Click here to view a list of    services that  require prior authorization.


Durable medical equipment

All services for durable medical equipment and prosthetic-orthotic services will require prior authorization from Northwood, Inc.

Security Health Plan has partnered with Northwood, Inc., to manage all durable medical equipment and prosthetic-orthotic services. Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive. Below are a few services that require prior authorization and need follow-up with Northwood.


Medical benefit drugs

 Medical benefit drugs (covered by Part B for members with Medicare)  are  injected or infused while you are in a provider's office, a hospital outpatient or ambulatory surgical center and may require prior authorization. In addition, home infusion services may also require prior authorization. 

These medical benefit drugs may be added or removed from this list quarterly on a calendar year basis. You can also call our Customer Service Department at 1-844-293-9624 to find out which medical benefit drugs require prior authorization.

Home infusion drugs

Some medical benefit drugs are eligible for coverage by home infusion. 

Skilled nursing services that require prior authorization

acute rehabilitation admission
long-term acute care admission
skilled nursing facility admission

High-end imaging services that require prior authorization

For all high-end imaging and radiation oncology services, you will need to work with your provider to receive prior authorization from eviCore healthcare.

For high-end imaging

www.evicore.com
Phone 1-888-693-3211
Fax an eviCore request form (available online) to 1-888-693-3210

For radiation oncology

www.carecorenational.com
Phone 1-888-444-6185

Services that require prior authorization

  • Abdominoplasty
  • Air ambulance transport
  • Amino acid formula
  • Autologous cultured chondrocytes
  • Back surgeries at all levels
  • Cardiac valve replacement
  • Carpal tunnel surgery
  • Clinical trials
  • Cosmetic and reconstructive surgery
  • Elective inpatient admission including   medical (acute and behavioral health) and surgical
  • Elective outpatient procedures such as, but not limited to:   carpal tunnel surgery, knee arthroscopy, back surgeries at all levels
  • Enteral feeding
  • Experimental or investigational services
  • Fecal transplant
  • Femoroacetabular impingement surgery
  • Gender reassignment
  • Genetic testing
  • Hearing aids for members over 18 years of age
  • Home health including but not limited to    skilled nursing, physical therapy, occupational therapy, speech therapy
  • Hospice
  • Hyaluronic acid
  • Infuse bone graft
  • Knee arthroscopy
  • Lung volume reduction surgery
  • MAZE procedure
  • Medical (acute and behavioral health)
  • Non-affiliated provider request
  • Non-emergent ambulance transport
  • Occupational therapy
  • Office procedure with site of service request other than in an office setting
  • Oral appliance for obstructive sleep apnea
  • Outpatient procedure with site of service request as inpatient setting
  • Outpatient therapy treatment (occupational therapy, physical therapy, speech therapy)
  • Physical therapy
  • Second opinion
  • Skilled nursing
  • Skin substitute
  • Spinal cord stimulation
  • Surgical
  • Swing bed admission
  • TMJ
  • Transplants